Provider Demographics
NPI:1932111218
Name:BACK IN ACTION CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BACK IN ACTION CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:DEREK
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:501-843-2222
Mailing Address - Street 1:1307 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:CABOT
Mailing Address - State:AR
Mailing Address - Zip Code:72023-3811
Mailing Address - Country:US
Mailing Address - Phone:501-843-2222
Mailing Address - Fax:501-843-2277
Practice Address - Street 1:1307 S PINE ST
Practice Address - Street 2:
Practice Address - City:CABOT
Practice Address - State:AR
Practice Address - Zip Code:72023-3811
Practice Address - Country:US
Practice Address - Phone:501-843-2222
Practice Address - Fax:501-843-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR15620111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR148748718Medicaid
ARU92200Medicare UPIN
AR148748718Medicaid